Discussion with Roger Van Zandvoort

The process of building the repertory and a glance to the roads ahead.

Yossi: So you are not practicing homeopathy, geographically live far away from the community, and deal only, so to speak, with the "technical" aspect of this art of healing… Is there something I can conclude of that?

Roger: Good question but difficult answer. The first reason I live here (Thailand) is because I met my wife here and the second is because all of my life I loved the tropical nature. My parents used to say "Oh Roger is with his brain in Africa" means dreaming of some place with elephants, orchids, butterflies.. My mind was far away from Holland, were I was raised, and I find it to be true… living here gives me balance, it gives me a good natural feeling, and that is a very good starting point for the work I do, because the work I do demands high concentration, reading, connecting.. so if you do that all day it's nice to have the possibility to walk out of the house every once and then, just clear up everything, just walk around in the garden a little bit, being in the sun.. That is a good charge of the battery. Concerning practice, I did practice in the past but I stopped doing that firstly because I love what I do, I believe the fact I like what I do also connected to the fact that I used to collect butterflies, plants,  taking pictures… and I do see the link between those hobbies and the work I do, it also got to do with collecting, with being very structural,  the second reason for me not practicing is that I can easily get impatient working with patients, there were some occasions when I kicked out patients (mainly because they did not tend to believe that the improvement they showed was due to the homeopathic treatment) and  can't consider that as a good starting point. But nevertheless with the work I do now although I do not treat patients directly, still I help colleagues to treat their patients with the best tools available, and if I do my work in a good efficient way it kind of goes way beyond the amount of patients which can be healed by me working only at the clinic.

Yossi: Seems to me as kind of an archeological work, this going through the earliest literature, checking stone by stone in order to come out with new findings.

Roger: Yea…and just as an archeologist needs to find the location which can give the best benefits still I'm try to look for the literature which can give the best profit, There are a lot of books in the literature which share basically the same data, so you needs to find those that can yield out the new findings.

Yossi: So after all the work done till now do you still see the possibility for new information from the earlier literature?

Roger: I'm trying to work in a structural chronological way, so now I'm into the literature of the years 1930-40, and what I'm looking for is mostly to read cured cases and to extrapolate repertory data from them. The chance to come out with new repertory additions is much better when you go through those cure cases rather than reading more and more materia medica which to some extent is very similar even though from different writers.

Yossi: So indeed is there any "news" found in those days literature?

Roger: Yes and as I said mostly if you go through and read the cure cases (the magazine which I just recently finished going thru all its publications is “The Homeopathic recorder" which I consider as one of the best and one of the most reliable sources in our literature), so what I'm actually doing is having those cure cases repertorized and then check if indeed the remedy comes up… For me when the remedy which made the cure does not shows in a reasonable place in the analysis than it’s  good news, because it means that there is a work to be done and data to be updated in the repertory.

Yossi: Say you go thru a clinical cases which shows again and again that a certain symptom (for instance an eruption) was cured by that remedy but still the main complaint (for instance: anxiety) was not cured, will you still add to the repertory this remedy under eruption ?

Roger:  I will not add to the repertory symptoms unless the overall picture of the pathology show improvement, so if some local symptoms shows improvement but the overall situation was not improved symptoms will not be added to the repertory. The other aspect of that is if you give a remedy to a patient and his overall situation is improving and some new symptoms also comes out than those new symptom also belong to the remedy  and should be added to the repertory.

Yossi: How does an ordinary working day in your life looks like, do you wake up and go immediately to those books you have?

Roger: (laugh), Oh no, I wake up in the morning, having a good breakfast, drink my coffee, go through the garden, check my mails.. you mentioned before that I live in a place far away from the homeopathic community but don't forget I have an enormous group in Facebook (Complete Repertory, Clinical Cases) of more than 22,000 members, and plenty of communications and correspondences happen there, well I might even say – as I hear it from several people – that I'm one of the most easily corresponding/connecting people in the community and interact a lot. I also like to post in that group repertorizations I do for interesting cases, the conversations following those posts are interesting and one can learn a lot from them.

Yossi: Do you still find new remedies in the literature or do you only make new additions to the rubrics from existing remedies?

Roger: There are also new remedies that I find in that literature, I would say 4-5 remedies added to the CR (Complete repertory) every year from such earlier literature. Beside of that early year's literature I do face a lot of pressure to update the CR with contemporary provings. The thing is that the older literature is backed with clinical cases whilst nowadays provings mostly are not yet supported enough or not at all with clinical experience (I expect the clinical cases to come initially from the proving master or the provers as they have the strongest affinity to the remedy and can recognize it in practice). The clinical cases are important also here because they have influence on grading of the remedy. A new proving with no clinical cases can easily be overlooked because of the low grading in the repertory once added, but once it comes with clinical cases confirming the proving-addition, then the grading becomes higher and the chance to have it higher in the repertorization is obvious. Nevertheless I do add contemporary provings but as I said it is important for me to have them supported with clinical cases. I can say for example that Jeremy Sherr is pushing hard to have new provings added to CR, and I can also say to his favor that whenever I ask him for clinical cases he does deliver the clinical confirmations.

Yossi: Do you only add material by certain protocol (i.e. Hahnemanian protocol) to the Complete Repertory or are you open to work also with other protocols?

Roger: Yes, The protocol is quite important to me, for instance dream provings I will not add to the repertory not because they are wrong but simply because they are missing physical information.  Mostly the mental-emotional information brought out by dream provings would be corresponding with the Hahnemannian protocol provings but they lack the physical information, so are incomplete provings.

Yossi: O.K. but as you said they do bring valid information in the mental-emotional level so why don't you add this at least?

Roger: Because I'm only one person and cannot handle that as well.

Yossi: So why don't you take someone to work with you?

Roger: Actually I do think about it. For years I worked by myself but only recently I came across someone whom I do consider to share the work with, this is Dr. Rajesh Rajendran‎‏ who runs the Facebook group together with me. It's not an easy step to share that work as it needs a combination of some digital platforms on which I'm editing information. But the time comes to collaborate in the work on the repertory, actually it also kind of connects to what you were discussing in your article [1] .

Yossi: Actually my call is for kind of extreme end collaboration. Here is a quote from my article to explain that:

"

… A tool which is basically a repertorization program, In that sense quite similar to the existing repertorization programs (Macrep, Radar, Complete Dynamics…) But… a web based version!!!   Web based so that data of users can be gathered and processed (off course under consideration of patient confidentialities).

There will be an internal "engine" which is able to access the cases and read the repertorization and the remedies given. The information generated by that engine (basically a collection of information based on how close the connections are between certain remedies and certain rubrics, founded on the clinical experiences of the users) will structure a new repertory, a Dynamic repertory which is constantly built and shaped with the flow of data.

Repertorization of successful cases and the remedy given will be processed…i.e. if a certain amount (the "certain amount" is a point to be discussed) of repertorization will show that the rubric fear/mice is quiet common in cases of calc. than the remedy calc. can be offered under that rubric and shows in the dynamic repertory.

"

Roger: Very good, I totally agree with you! Actually there were and I think still are some similar projects which require homeopaths to upload their data to a server and once you have enough information collected, than you can analyze it to yield new information from it. Another project is to upload the exact wording of the patients as taken in clinic and to try to extrapolate from them the relevant rubrics, of course also the remedy and potency information that made the cure must be there, so again by analyzing that information you can have new and solid information to be added to the repertory.

Yossi: I think that developing a "machine" capable to read the cases as spoken out in the clinic and to extrapolate from the text the relevant rubrics means to deal with the highest level of artificial intelligence with huge costs and very complicated work to be done, and still I will doubt the benefit of that (just give the case to be repertorized by two homeopaths and see that each one of them will suggest different rubrics, Not to mention strategies). What I believe is better is to focus only on the repertorizations made in successful cases and by analyzing them you can easily see how tight is the relationship between a certain rubric and a certain remedy is.

Roger: Well yes,  One more thing you need is a balance system, an editor which will looks through the data and know which of the information is in line with their clinical experience, the expertise of the clinician,  may be some experienced homeopaths will need to be editors in charge.

Yossi: Well, I would say that my concept is in a way much more anarchistic, I don't want someone to "own" and edit the data for me, data belongs to the community and so it needs to stay, and concerning the balance system, surely I offer some suggestions which can secure the quality of data. Again here is a quote from my article:

"

…In order to secure the reliability and quality of data there will be user preferences, by adjusting those preferences every user can secure the creditability of data, some examples for the preferences:

  1. Exposure scale: Each user can define the volume of users and data to be exposed to, means which is the data you allow your software to read and to gain value from (probably the data you consider as trusted and interested enough.)

You may start by defining only your cases as trusted enough and by that it means that only your clinical cases will be processed by the software engine. You may define only well-known users to access and read their data, you may also define that only homeopath from certain creditability scale are safe enough to read their data.

  1. Creditability scale: There will be a creditability scale, say from 1-10, for every user. Creditability scale will be effected from the amounts of credits (Kind of a "like" button) you gain from the community. The more credits you get from the community means the more solid and trusted is your data.
  2. Remedy rank: each remedy addition offered by the software will have its rank affected by the intensity of the correlation between the remedy and the rubric, how intensive and affirmative is the correlation between the remedy and the rubric in the clinical experience.

Anyway, one must pay attention to the fact that the preferences to define the creditability of data can always be changed…. So whenever you feel that your data seems to be loose a bit you may change your preferences to be more restricted and consequently the data (and the dynamic repertory created by that data) to be more solid…

"

Roger: Yes, This is a balance system which can serve to secure the reliability of data. This is a starting point.

Yossi: Thanks. There are new rubrics added to the repertory every now and then, I believe there are a lot of earlier remedies which could find their way to those rubrics, but they will not show in those rubrics simply because the rubrics were not in the repertory at the time those remedies were proved. Say for instance rubrics concerning radiation sensitivity.

Roger: Correct, this is also one of the reasons I try not to make new rubrics, and if I made a new rubric… well if it is a very specific one so you know that any way there are only a few remedies which can cover that, but still whenever there is a new specific rubric added I try to connect it with the more general rubrics. I give you an example: Mind/restlessness/morning/after yawning. Say it is a new rubric with only one remedy… So in order to open up similar possibilities I will cross reference that new rubric with general/yawning after or Mind/restlessness so the homeopath is able to jump to a similar rubric and may there find the remedy he/she looks for. Off course you can also cross two more generalized rubrics and that will give you an important new rubric. In the example you can cross the rubrics: Mind/restlessness and general/yawning after to get to the remedies that cover both rubrics.

Yossi: O.K. but still there are those new rubrics, mostly I see them in the mind section, Where there are may be 30 remedies, and they are all recently proved remedies.

Roger: Right, I give you a good example of a rubric I just came across today: Mind/freedom/desire for, kind of a modern day rubric which belongs to the time we are living in and most likely people in the past were not dealing with those topics in the way we deal with them, were not expressing themselves in that manner as part of pathology.

Yossi: what makes you define clinical information as reliable?

Roger: Well as I said most of the information I get comes from going through cases I find in the old literature, In that sense I do have to rely on a good and reliable selection-work done by the editor of the magazine. So surely there is an assumption that material published in a journal has therefor some level of reliability.

Yossi: Is it happened that clinical cases you rely upon might also be a case send to you by a practitioner or you rely only on professional publications?

Roger: I have decided already long time ago that what I want is written down publications and not any information send to me by private correspondences. This is because I want the colleagues using the repertory to have a reference for the source of information they come across. There are some exceptions I made, like Vithoulkas and Sherr who send me clinical cases not officially published but this is very exceptional and depends on the reputation of the practitioner. As you can imagine I do receive a lot of mails from colleagues worldwide writing that upon their clinical experience this remedy should show in that rubric etc.  etc. but then my answer would be please publish it so I can refer to it in a proper manner.

Yossi: let's speak about mega-rubrics, say those rubrics which contain more than 500 remedies. Personally I try to avoid working with them, they make the analysis looks blurred and not clear enough, dilute it. Now naturally along history every rubric almost gets larger and larger, so how can we avoid a future situation when the repertory is loaded with too much of mega rubrics?

Roger: This accumulation of remedies in rubrics can only happen to a certain kind of rubrics, rubrics which indicate remedies in quite a general way. I do agree with you that those rubrics are not beneficial in an analysis as such, but if you use them for crossing with other rubrics they can be quite beneficial. Beside that they are simply there because the repertory is an index of all symptoms. The ability to cross them though can be of great value in analysis.

I would like to add that there is also a problem in our grading system, a problem that limits their usability. I will explain, It does not matter if we refer to Bönninghausen’s or Kent’s way of grading, still their grading system reflect only the information for a specific remedy coming from the proving (grade 1 in Kent’s and grades 1-2 in Bönninghausen’s) and confirmed by clinical cases (grade 2-3 in Kent’s, and 3-4 in Bönninghausen’s). But there is a similar important parameter which their grading systems do not take into account, do not specify, which is the exact amount of times a certain remedy is confirmed in a certain rubric again and again from different sources. I call it the exact frequency parameter, which is limitless, while the original grading systems are limited to grade four. So if you take for instance a mega-rubric like General/waking/agg you see that Lach. there appears in grade 4 together with some other 200 remedies also graded 4, but there is a huge gap between the Lach. and the other remedies also shown in grade 4, Lach. is confirmed under that rubric by far more instances, has a far higher frequency than any other remedy, which means the certainty of Lach. under that rubric is much higher than any other remedy, and this important information will not show itself by looking in the repertory. Reading the repertory you see only which are the remedies under certain rubric and their grading, but you don't see at all how affirmative and solid is the appearance of the remedy there when expressed in frequency of appearance. With that I do think that the concept offered in your article of having the community information shared and analyzed you can learn more and more for how solid and reliable is a certain frequency of a remedy in a rubric. Some of the repertorization programs have access to that information in the Complete Repertory so the analysis made by them is not simply reflecting only the amount of symptoms and the grading but also on the frequency of appearance of the remedy as mentioned above. The Complete Dynamics program for instance.

Yossi: So in a way a three dimensional look needs to be adapted to the rubrics rather than the two dimensional look we used to have. Rather than looking in a rubric to read only the remedies shown and their grading you suggest a third factor (frequencies) reflecting to show how solid and reliable the frequency of a remedy in a rubric is as expressed by the exact amount of clinical confirmation.

Roger: Yes, The situation today is we are to consider a scale of 1-4 in grading, indicating that grade 1 means experienced only by one prover, grade 2 means experienced at least by two provers, grade 3 confirmed at least by one clinical case and grade four means confirmed by 6-8 clinical cases (this is not a written rule, I came to learn it from years of doing my work). Now this third factor actually says: why should we limit ourselves to grade four, what about those remedies confirmed by 50 clinical cases? Should they be graded 4 just as their neighboring remedy confirmed only by 6 clinical cases?

Yossi: One more thing concerning the grading of remedies, people often get confused and consider the grading of a remedy as reflecting the remedies intensity rather than its probability, would you like to say some words about that?

Roger: Big problem, very big problem. The grading system has nothing to do with the intensity of symptoms, it's all about the probability of a remedy, how many provers experienced the symptom for that remedy and how often was it confirmed by clinical cases, that’s it. The intensity is not at all reflected by the grading but rather by the wording of the symptom, for instance: fear/panic attack, that indicates intensity, or Extremities/heaviness/lead like, that is intensity. People often get confused between probability and intensity, even in provings I receive, proving masters tend to waver between probability and intensity when they try to indicate the grading.

Yossi: If I have to state two symptoms which are very indicative for Carc. I would say Sympathy and fear of control loosing, But Carc. does not show under fear of control loosing, how come?

Roger: As said I'm trying to work chronologically and now I'm around 1930-40 so carc. was not yet proved at that time, the data you see come mainly from clinical information I received or found in the literature. Of course the more clinical cases I study that will show carc in correlation with fear control losing the better chance it will show there, so this shows how important is a platform which will enable the community to share their information about remedies and rubrics.

Yossi: Anything else?

Roger: I think that a lot of practitioners experience difficulties in translating the patient wording to the repertory rubrics.

Yossi: I believe that these difficulties mostly come when you are dealing with the physical symptoms and less with the mind symptoms, I always thought it would be nice if we had an image of the human body which you can point your mouse to and dig to the specific location/organ your patient is speaking of and there be able to see its rubrics in the repertory.

Roger:  Having that image is a thought I had in mind from the very beginning of Complete Dynamics but there are always more important projects to deal with, still we have in Complete Dynamics the painting of the Vitruvian man by Leonardo da Vinci in which you can click on a part and get to the specific chapter but of course not yet segmented and detailed as I wanted it to be.

[1] Yossi Tagori, "Call for a new concept of homeopathic software" – Homeopathic Links Vol. 30, 2/2017

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